Capario

Connectivity. Solutions. Insight.

Payer Solutions

Capario offers payers a full range of electronic transaction processing services. Our standard transaction services include:

  • Electronic claims (professional and institutional)
  • Eligibility
  • Claims status
  • Referrals/Authorizations
  • Electronic Remittance Advice
  • Workers Comp eBills and attachments
  • Medicare crossover services

In addition, Capario offers a series of advanced scrubbing, automation services as well as a Web-based management application. 

Advanced Claims Scrubbing Services
For payers, the ability to catch claim errors before processing greatly streamlines workflow and reduces costs. Capario solutions routinely eliminate many basic and advanced mistakes by scrubbing claims for clearinghouse and HIPAA-related edits, as well as payer-specific edits. We also offer specialized services that pre-screen for clinical code edits and possible fraud/abuse. The net result is delivering payers the cleanest claims possible resulting in the highest auto-adjudication rates possible.   

  • Fraud and abuse detection discovers unlicensed or unsanctioned providers, high-risk addresses, past investigations or suspected billing patterns. We apply this screening technology as an optional filter for all of a payer's inbound claims.
  • Clinical code editing in a pre-receipt and pre-adjudication environment is an optional filter that checks for issues such as medical necessity, service over-utilization, procedure-to-diagnosis issues and code validity, avoiding the expensive process to reverse payments.

Automation Services
Capario, through its partnership with Tela Sourcing, offers payers the ability to scan paper claims and convert them to electronic form, reducing operational expenses and maximizing auto-adjudication rates.

With these services you have assurance that you are processing only the cleanest claims and reimbursing the appropriate amount for the healthcare services provided.

Web-based Payer Management Portal
Capario's payer portal allows payers to monitor and manage submitter volume in real-time. With access to views by submitter, payers can watch trends on their incoming volume and work with problem submitters to establish best practices for billing.

Payers Optimize Performance
Capario's solutions help you improve your operations by delivering significant financial and operational benefits:

  • Build stronger provider relationships through simplified, collaborative processes
  • Gain operational efficiencies with receipt of cleaner claims and reduce inquiry call volumes by providing real-time information
  • Simplify processing and reporting by aggregating claims into one repository from a single vendor
  • Minimize costs by pre-screening for detection of fraudulent patterns and providing remittance advice electronically to reduce paper-based processes
  • Streamline and simplify Medicare Crossover claims-related workflow, with no need to reformat

To learn more, request a demonstration, contact sales by email, or call 800-586-6870.

Capario provides a powerful solution that helps optimize efficiencies in payers' claims processing cycle through real-time transactions and direct communications.